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PLEASE HAVE THE BELOW AVAILABLE BEFORE BEGINNING YOUR APPLICATION

 Veterinarian's Authorization Code (False codes submitted will result in immediate disqualification)

 Copy of ID for all adults responsible for pet in household

 Copy of Care Credit or Scratch Pay Results for all adults responsible for pet in household

 If requesting more than $500, proof of income for all adults responsible for pet in household

 Proof of participation in financial assistance programs (PGE, etc) if applicable.

 Photo of your pet 

ELIGIBILITY CRITERIA

 Pet owners must RESIDE in Monterey County to be eligible to financial assistance

 Approved pet owners will receive a one-time pet health care grant of up to one-half of veterinary care costs or a maximum of $1500 – whichever is lower. At no time do we cover the cost of the entire procedure.

 Funds are only paid to Veterinary Partners providing treatment for your pet.

 Primary Applicant (Pet Owner) must be an Adult, over 18 years old.

 Pet owners must apply for Care Credit or Scratch Pay

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PET OWNER & SPOUSE/PARTNER/PET CO-OWNER INFORMATION

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First Name
Last Name
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First Name
Last Name
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Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code
Country
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PET'S INFORMATION
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If your pet is a mix, list the one or two most prominent breeds
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(If you do not have a regular veterinarian, explain why not here)
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HOUSEHOLD FINANCIAL INFORMATION
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Note: Scratch Pay can only be used as an option if the treating veterinary practice accepts it as a form of payment.





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Friends, family members, other non profits
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I understand and agree that:
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You MUST submit ID and Care Credit Results in order for us to process your application. You can submit through this form, or by emailing to admin@maxshelpingpaws.org.

You must submit either through form or by sending photo of your ID/DL to admin@maxshelpingpaws.org

You can email this separately to admin@maxshelpingpaws.org. Please reference your pet's name and your last name.

If requesting more than $500


I accept and approve the above. If I receive assistance, I consent to use of my pet’s name, image & story by MHPF for website, PR, and other marketing purposes, AND I will cooperate with MHPF to schedule photos, interviews or video as necessary for their use.

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